HomeMy WebLinkAboutMINUTES - 06231998 - C31 CIABOARD Of SUPIRMM Of COAMA COSTA CD-UMs !CALUK&N1AIM
BM ,
Claim Against the County, or District Governed by
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All 'Vection?references are to l The copy of this document mailed to you is your
California Government Codes. 1 notice of the action taken on your claim by the
Board of Supervisors. (Paragraph 1V below), given
pursuant to Government Cade Section 913 and
915.4. Please note all "Warnings".
AMOUNT: $246.82 R3(Z1311WM3)
CLAIMANT: Mary E. Casey 199
ATTORNEY: DATE RECEIVED: TIN CAL �
ADDRESS: 4429 Meadowbrook Drive BY DELIVERY TO CLERK ON:
El Sobrante CA94803
BY MAIL POSTMARKED: May 25 1998
L FROM. Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim,
PHIL BATC LOR, Clerk
Dated: May 26, 1998 By: Deputy
El FROtL• County Counsel TO: Clerk of the Board of"Su ervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Board cannot act for 15 days (Section'910.8).
( ) Claim is not timely filed. The Clerk should return claim'on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: I By: c .�,t.s - - .L e Deputy County Counsel
III. FROtL• Clerk of the Board TO: County Counsel (1);, County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
TV. BOARD ORDER: By unanimous vote of the"Supervisors present:
This Claim is rejected in full.
Other:
I certify that this is a true and correct copy of the Board's Order ente d in its minutes for this date.
Dated: ' 'HIL BATCHELOR, Clerk, By ty Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only six (6) months from the date this notice was=personally served or deposited
in the mail to file a court action on this claim. See Government Cade Section 945.6. You may,seek the advice of an
attorney of your choice in connection'with this matter. If you want to consult an attorney, you should do so'
immediately. `For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING'
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United
States, over age 18'; and that today I deposited in the United States Postal Service in Martinez, California, postage fully
prepaid a certified copy of this Board Order and Notice to Claimant, a ressed to the claimant as shown above.
Dated:, ,lam y: PML BATCHELOR B' duty Clerk
CO. County Counsel County Administrator
�3f
Clain to: BOARD OF SUPERVISORS OF COMU OOSTA COMM
wmcrio s Tio cuDiw
A. Claims relating to causes of action for death or for ;injury to person or to per-
sonal property or growing,crops and which accrue on or before December 31, 1987,
mint be presented not later than the 100th day after'the accrual of the cause of
aetic n. elms relating to causes of action for.death or for injury to person
or to personal property or growing amps which accrue on or after January 1,
1988,: must be presented not later than sic months after the accrual of the cause
of action.. Claims relating to any other cause of action gust be presented not
later; than one year after the accrual of the cause of action. (Govt. Code 5921.2.)
B. Claims must be filed>with the Clerk of the Board of Supervisors at its office in
Room 106, City Administration Building, 651 pine Street, Martinez,: CA 94553.:
C. if claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity. ,
E.' Fraud. .See penalty for fraudulent claims, Penal. Code See. 72 at the end of this
RE Claim By } Reserved for Clerk's filing stamp
RE E1VF2:"
Agan the County of Contra Mi to
or' E
District)
nam:
The undersigned claimant hereby rakes claim int the 'County of Contra Costa or
the above-named District in the sure of i -- and in support of
this claim reresents -as' follows:
1. When did the damage I or injury occur? (Give exact date and hour
2w Urnere did the damage or injury occur,? (Taclude city and countrV\ }
� -' :.S.r
3. Row t id the damage or injury occur? '(Give full details; use extra ipaper; if
required)
EJ ' '
4. What partlar act or omission on tie part of county or district officers,
servants or .employees cawed.the.injury or damage?
�AjN-Av
(aver)
wnat are the names of county or district officers, servants or employees causing
the damage or injury?
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
' l 4-..�... ` C cod 'D �'\' t
?. H014.)was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
B. Names and addresses of witnesses, dvvtorxs and hospitals.
9. List the expenditures you made on 'account of this accident or injury.
BATE ITEM AMOUNT
Gov. Code Sec. 91.0:2 provides
"The claim must be signed .by the claimant
SEND NOTICES TU. (Attorney) or by g9m,verson on his..behalf."
Name and Address of Attorney
ClaUKants SxgnatureT
Address
rte'Il n
_J,
,, ;�,L'
Telephone No. Telephone Na. ' _
NOTICE
Section `72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, ;or to any county, city or district board or
officer, authorized to allow or pay the same if .genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail-for a period of not more than one;-year, by a fine of not exceeding
one thousand '($1,000), or by`both suchimprisonment and fine; or ;by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,0009 or by.
both such imprisonmentand fine.
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ClaimAgainst the County, or District Governed by
the Board of Supervisors, Routing Endorsements,` ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document railed to you is your
California Government Codes. ) notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV below), given
pursuant to Government Code Section 913 and
915.4. Please note all "Warnings".
AMOUNT: $409.35 s
CLAIMANT: Norman Jay Chavez
JUN
ATTORNEY: DATE RECEIVED: COUNTY COUNSEL
MARTINEZ CALIF.
ADDRESS: 4039 Skylark Lane BY DELIVERY TO CLERK. ON:
Danville CA 94506
BY'MAIL POSTMARKED: June 4, 1998
L FROM: Clerk of the Board'of Supervisors TO: County;Counsel
Attached is a copy of the above-noted,claim.
PHIL BATCHELOR, Clerk
Dated: _ June 8, 1998 By: Deputy 117 '
H. FROM: County Counsel TO: Clerk of the Board of Supervisors
.This claim complies substantially with Sections 910 and 910.2.
{ } This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
Board cannot act for 15 days (Section 910.8).
{ } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late claim {Section 911.3}.
{
) Other:
Dated: {�
By: Deputy County Counsel
TCI. FROM: Clerk of the Board TO: County Counsel {1} County Administrator (2)
{ } Claim was returned as untimely with notice to claimant {Section 911.3}.
TV. BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
Other:
I certify at this is a true and correct copy of the Board's Order ente` d in its minutes for this date.
Dated: PHIL BATCHELOR, Clerk, By: ' Clerk
WARNING (Gov. code section 913)
Subject to certain exceptions, you have only`six (6) months from the date this notice was personally served or deposited
in the mail to file a court action on this claire. See'Government Code Section 945.6. You may seek the advice of an
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice'.
AFI{TDAVIT OF'MAHJNG
I declare under penalty of perjury that„I am now, and at all times herein mentioned,'have been a citizen' of the United
States, over age 18 and that today I deposited in the United States Postal Service in Martinez, California, postage fully
prepaid a tified copy of this Board Order and Notice to Claimant, a dressed to the claimant as shown above.
Date y: PHIL BATCHELOR B uty Clerk
CC: County Counsel County Administrator
z_
Claim to: Bay OF SUPERVISORS of tIDNTRA COSTA CMM
I MUCTIONS TO CLAD4ANT
A. Claims relating to causes of action for death or for injury to person or to per-
sonal property or, growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to !causes of action for death or for injury to person
or to personal property or gnawing crops and. Which accrue,on or after January 1,
1988, must be presented not;later' than six months after the accrual of the cause"
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code 1911.2.
B. Claims 'must be filed with the Clerk of the Beard of Supervisors at its Office in
Room 1069 County Administration Building, 681 Pine Street, Martinez, CA 9 553.
C. If claim is against a district governed by the Board of Supervisors, rather than
the County, the name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be
filed against each public entity.
E. mud. See ,penalty for fraudulent claims, Penal Code Sec. 72 at the end of this
Form.
RE: Claim By ) Reserved for Clerk's filing 'stamp'
RECEIVED
JUN 5 1998
Aga nst the County of Contra Costaor }
CLERK BOAR€?of S0FERV11,0pfi
CONI a COSTA Q.
District)
MITT n }
The undersijhed 6-1 imant hereby',makes claim against the County of Contra Costa:or
the above-named District in the sum of $ and in support of
this claim represents-as follows:
..s.w.��rr...� urw.rr..rr.iw.r....riw._s..+rr.::. -......_..........r�_.:........__...�r_..rwc,�.rr..�.wa..�_
1. When did the damage or injury occur? (Give exact date and hour)
��r��_yr,r..,rw..r.iaTWi��_wrr �� I�..,.arrr__rrr.rr+r+.4rr.rr.rr...s.wrarr+.r.+rr_.rrrw
2. Where did the 1damage or injury occur? (Include city and county)
6*t i ti k'
3. How did the damage or injury occur? (Give full detaiuse extra paper if
required)
What partioul act or omission on the part of county or district officers,
exkvarts or employe moused,the injury or damage?
4- � ".
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P'. i 5" i,rJ
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Wriat are the names of county, or district officers, servants or employees causing
the damage or, injury?
�w .w.rar..«Ilr.r+w+++rir+.�M.i.rwrr+.rr.rr.nrrw.r.rad..rr+rr+aw+M+...rw.rrr.r+ r"+rr.+Mwr----r-----r+r-------
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto'da ,ge.:-
..•)y
� i11 AMM _!:I M MW w YM+YM Mi.M4r YOMM IMN�IiY �r`iIWwMMMYi41YY/ww. +�rarr
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or die.)
4V ;44
Names and addresses of witnesses, doctors and hospitals
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
GoV. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Aor b some 2erson on.14s.behalf."
Name and Address of Attorney
laimant's'Signa
(Address)
Telephone No Telephone No.&S, eS
A s
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any;county, city or district board or
officer, authorized to allow or pay the same if . enuine, any false or fraudulent
claim, bill,,. account,,, Voucher, or writing, iso punishable either by imprisonment in
the county fail for a period of not more than one 1 year, by a fine of:not exceeding
one thousand ($1,000), or by both such imprisonment and fine,= or by imprisonment in
the state prison, by a fine of notexceeding ten thousand dollars ($10,000 or by
beth such imprisonment and fine.
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